The Cost of War Includes at Least 253,330 Brain Injuries and 1,700 Amputations

Here are indications of the lingering costs of 11 years of warfare. Nearly 130,000 U.S. troops have been diagnosed with post-traumatic stress disorder, and vastly more have experienced brain injuries. Over 1,700 have undergone life-changing limb amputations. Over 50,000 have been wounded in action. As of Wednesday, 6,656 U.S. troops and Defense Department civilians have died.

That updated data (.pdf) comes from a new Congressional Research Service report into military casualty statistics that can sometimes be difficult to find ' and even more difficult for American society to fully appreciate. It almost certainly understates the extent of the costs of war.

Start with post-traumatic stress disorder, or PTSD. Counting since 2001 across the U.S. military services, 129,731 U.S. troops have been diagnosed with the disorder since 2001. The vast majority of those, nearly 104,000, have come from deployed personnel.

But that's the tip of the PTSD iceberg, since not all ' and perhaps not even most ' PTSD cases are diagnosed. The former vice chief of staff of the Army, retired Gen. Peter Chiarelli, has proposed dropping the 'D' from PTSD so as not to stigmatize those who suffer from it ' and, perhaps, encourage more veterans to seek diagnosis and treatment for it. (Not all veterans advocates agree with Chiarelli.)

The congressional study also brings to light the extent of one of the signature injuries of the post-9/11 wars, Traumatic Brain Injury (TBI), often suffered by survivors of explosions from homemade insurgent bombs. From 2000 (a pre-9/11 year probably chosen for inclusion for control purposes) to the end of 2012, some 253,330 troops have experienced TBI in some form. About 77 percent of those cases are classified by the Defense Department as 'mild,' meaning a 'confused or disoriented state lasting less than 24 hours; loss of consciousness for up to thirty minutes; memory loss lasting less than 24 hours; and structural brain imaging that yields normal results.'

More-severe TBI is measured along those metrics, lasting longer than a day. Nearly 6,500 of of those cases are 'severe or penetrating TBI,' which include the effects of open head injuries, skull fractures, or projectiles lodged in the brain.

Like with PTSD, the TBI diagnoses scratch the surface. The military's screening for TBI is notoriously bad: One former Army chief of staff described it as 'basically a coin flip.' Worse, poor military medical technology, particularly in bandwidth-deprived areas like Iraq and Afghanistan, have made it uncertain that battlefield diagnoses of TBI actually transmit back to troops' permanent medical files.

Amputations are a feature of any prolonged war. Almost 800 Iraq veterans have undergone 'major limb' amputations, such as a leg, and another 194 have experienced partial foot, finger or other so-called 'minor limb' losses. For Afghanistan veterans, those numbers are 696 and 28, respectively.

The Iraq war is over for all but a handful of U.S. troops and thousands of contractors. The Afghanistan war is in the process of a troop drawdown through 2014 of unknown speed and will feature a residual troop presence of unknown size. Even if the U.S. deaths and injuries in those wars may almost be over, the aftereffects of the wars on a huge number of veterans will not end.